Prisma Health and United Healthcare still in negotiations, patients express concerns

GREENVILLE, S.C. (WSPA) – It has been more than six months since negotiations between United Healthcare and Prisma Health began.

They have yet to come to an agreement on a rate that Prisma Health will charge patients and a rate that United Healthcare will pay Prisma.

The battle between Prisma Health and United Healthcare continues, and patients said that they are suffering.

Nearly sixty thousand patients are feeling the impacts affected as Prisma Health, the largest healthcare system in the area and United Healthcare, the largest insurance provider in the country, battle over rates.

It’s been a back and forth issue, where both sides blame the other.

“In the past year, we have reached renewal agreements with every other health insurance company and remain in their networks because their terms were fair and reasonable,” Prisma Health said in a statement.

“Our latest offer would ensure Prisma is reimbursed at rates that are more than fair and reasonable,” United Healthcare said in a statement.

Patients said no matter what company is at fault, they are suffering.

“I had to have foot surgery,” Anita McLeod, an affected patient said. “I knew that if I went to a Prisma Doctor, it would be over $100 to see him and the surgical costs were going to be out of sight. I had to search and I wound up having surgery in Spartanburg.”

Since January 1, United Healthcare has been out-of-network with Prisma Health.

“Typically, the cost for a visit is much higher for out of network,” Dr. David Brancati, an unaffiliated Emergency Care Physician said. “In fact, many of the plans might not have much coverage at all.”

If patients still want to see their Prisma Health doctor, they can apply for “continuity of care” but will have to pay out of pocket fees.

“They sent us a bill that has to be paid before the visit which is basically what they call a self-pay bill and off that was a discount anywhere between 35-50%,” Gene McLeod said. “It still left me having to pay $125-$130 just to be able to see this particular doctor.”

Gene McLeod said he would have previously paid between 12 to 15 dollars.

For him he and his wife, Anita, they can’t risk to see doctors who don’t know them best.

Anita said she has battled cancer three times in the last 20 years.

“I have had another scare and so my surgeon said I am not willing to let you go 6-8 months,” Anita McLeod said. “I need to see you every other month.”

Dr. David Brancati, who is unaffiliated with either system, said the issue is not easy to solve.

“You have hospital systems getting larger and encompassing more territory,” Dr. Brancati said. “By that, they have leverage over the insurance companies and Insurance companies want to expand their networks, get more patients and have more leverage over the hospitals. By saying they have many more members, and ‘if you don’t accept us’, then you’ll be missing out on a lot of business.”

Prisma Health told 7News “In the past year, we have reached renewal agreements with every other health insurance company and remain in their networks because their terms were fair and reasonable.”

United Healthcare said, “Our latest offer would ensure Prisma is reimbursed at rates that are more than fair and reasonable.”

As Dr. Brancati described it, it’s tug of war between Prisma Health and United Healthcare. At this time, it is still unclear when they will come to an agreement.

The McLeod’s are offering a tip for patients affected like them. They said if you want to still see your Prisma Health doctor, you can call the patient advocate department with Prisma for additional help.

For the latest news, weather, sports, and streaming video, head to WSPA 7NEWS.